Surviving Long Hours and the Night Shift

This article was originally written for nurses but applies well to respiratory care and sleep medicine professionals.

Many respiratory care therapists and sleep technologists put in 12-hour shifts, while others work night shifts. Although these types of schedules are expected as a requirement of their job, many medical professionals expose themselves to different types of health risks that often are associated with prolonged work hours and disruptions to a normal circadian rhythm. To avoid health issues, it is critical to understand the nature of the problem and provide shift workers with ways to reduce risks and manage late-shift schedules.

Many health problems can be directly attributed to lack of rest and sleep. Not getting enough rest could lead to symptoms such as slower reaction time, impaired learning ability, slower cognitive ability, moodiness and sudden drowsiness. People also may suffer from impaired cognitive flexibility and communication skills.

These symptoms can pose some serious threats to nurses and their ability to perform their job accurately and correctly. They could, for example, commit errors and inaccuracies in the administration of drugs, suffer from syringe needle injuries and other medical tools, or make mistakes in the use of medical equipment. In a study published in 2004 by Rogers et al, it was shown that a nurse is three times more likely to make an error while working in shifts that extend to 12 and a half hours or more, compared to working shifts that lasted just 8 and a half hours.

Strategies to Manage Long Hours and Night Shifts

Respiratory Therapist, Sleep Technologists, Nurses, hospital workers and management staff can take certain steps to improve working conditions of medical professionals who work long hours or at night, including:

Allowing nurses to take naps during night shift
Research suggests that nurses who work 12-hour shifts or longer should be allowed to take one-hour naps. The nap breaks are similar to scheduled meal breaks and will provide much-needed rest.

Working in well-lit areas
Light sends a signal to the body’s circadian rhythms and is known to increase alertness in people.

Consuming caffeine
Coffee and tea contain caffeine, a brain-changing chemical that helps people stay alert. It works well for short periods but must not be consumed at very high doses.

Eating better
Sugary foods and drinks may provide a sudden burst of energy, but they also cause the dreaded sugar crash. By eating well and avoiding sugar, nurses can help minimize sleepiness.

Performing short exercises
Exercising for short periods of time — under 30 minutes — has been known to help people stay awake and alert.

Not working consecutive nights
Working consecutive night shifts puts a heavy demand on an individual’s body and mind, and should be avoided as often as possible.

Ineffective strategies
Two of the most common strategies that people use to keep awake include playing loud music and staying in a cold room, neither of which works.

Risks Associated with Increased Work Hours

People who work the night shift have a 28 percent greater risk of experiencing fatigue-related errors and accidents. Evening workers, on the other hand, have a 15 percent higher risk. People who have 10-hour work shifts also have a 13 percent higher risk for errors and accidents, while workers on 12-hour shifts increase their risk to 28 percent. A report published in 2006 by Simon Folkard and David A. Lombardi showed that increases in consecutive night shift work also increased risk by about 17 percent by the third night. By the fourth night, the risk more than doubles at 36 percent.

Strategies for Reducing Fatigue-related Accidents or Errors in the Workplace

One key option to consider is allowing nurses to work regular schedules and avoid backward rotations — that is, changing from day shift to evening shift and vice versa. Two-week rotations also should be implemented instead of weekly rotations. In addition, management should consider changing shifts multiple times a week instead of weekly, and employees should be allowed to work in pairs or teams instead of alone.

Policies encouraging workers to take naps during their shifts also should be implemented. To accomplish this goal, companies should implement processes for awakening those who are taking nap breaks, provide comfortable sleeping environments and have sufficient manpower to take the place of napping workers.

Health Risks for Night Shift Workers

The American Journal of Preventive Medicine published a study showing that individuals who worked for at least 15 years on rotating shifts have a greater risk of developing and dying from lung cancer. Women who work night shifts on rotation for at least five years also tend to have shorter lifespans and increased risk of developing cardiovascular disease. Night shift workers also may develop health problems such as hypertension, high blood sugar levels and high cholesterol, as well as a wider waistline circumference. Both men and women also have a higher risk of developing cancer that affects the reproductive organs, which may be due to exposure to light at night.

Managing Night Shift Work

The most important thing to remember is to preserve one’s circadian rhythm by ensuring regular sleep patterns. Sleeping during the day comes with certain challenges that could be managed but never totally avoided. To improve sleep quality, try using earplugs and blackout drapes. It is also important to have enough sleep. If caffeine is needed to stay alert, it should not be consumed in such amounts that it disturbs one’s ability to sleep.

How the Circadian Rhythm Works

Circadian comes from the Latin word “circa diem,” which means “about a day.” It is the body’s internal clock, taking cues from the environment by alternating between darkness and light. This biological clock is found in the suprachiasmatic nuclei of the hypothalamus. The circadian rhythm’s purpose is to program the body’s daily sequence of changes in behavioral and metabolic systems. Most individuals work on a circadian rhythm of 24 hours and find it easier to delay the clock than advance it. Night owls, however, can delay the biological clock better, while larks are better at advancing it. The circadian rhythm is believed to be helpful in suppressing tumors.

Melatonin, a type of hormone, serves as a shift indicator in the timing of our body’s biological clock. It is the reason why night shift workers find it more difficult to adapt if they are exposed to strong light particularly in the morning when they return home. Melatonin treatment also may help workers delay or advance their biological clock as needed.

Another key biological component is called the diurnal preference, which refers to individual differences and one’s preferred timing involving waking and sleeping activities. The diurnal preference plays a role in the ability of individuals to adapt to biological clock changes.

A recently released analysis showed that fewer than three percent of workers who worked nights permanently were able to adapt their circadian rhythms, and fewer than 25 percent were able to adjust to benefit from this shift. Charmaine Eastman, Ph.D., a physiological psychologist for Rush University, Chicago, identified a strategy that could help night shift workers. She suggested that workers expose themselves to intervals of strong light during their shift and to wear dark glasses when going home in the morning. However, circadian rhythms cannot fully adapt to changes that come with shifting from night work to day work.

Why Night Shift Work Remains Popular

Many individuals prefer working the night shift because it offers more opportunity for work experience since there is less competition. There are also fewer disruptions and distractions from coworkers and management, fewer meetings and shorter commutes since there is less traffic. Better employment opportunities and competitive pay are additional advantages to working the night shift.